AB1009 EXERCISE IS ASSOCIATED WITH HIGHER BONE MINERAL DENSITY IN PATIENTS WITH POLYMYALGIA RHEUMATICA AND VASCULITIDES
Authors: A. Palmowski, E. Wiebe, S. Hermann, B. Muche, F. Buttgereit
Journal: Annals of the Rheumatic Diseases (2022)

Background Exercise is an effective non-pharmaceutical intervention for osteoporosis (OP). However, it has not yet been explicitly validated whether it is associated with bone mineral density (BMD) in patients suffering from polymyalgia rheumatica (PMR) and vasculitides. Objectives To assess whether exercise is associated with BMD in PMR and vasculitis patients. Methods We evaluated baseline visits of patients enrolled in the monocentric, prospective “Rh-GIOP” cohort. Patients were included when having PMR or any kind of vasculitis. Simple and multiple linear regression models with minimum T-score (lumbar spine or hip, whichever was lowest) as the dependant variable were constructed. A dose-response analysis (frequency of exercise per week) was conducted in patients who were doing any kind of exercise. In multiple regression, we adjusted for potential confounders associated with minimum T-scores in an analysis of the overall cohort ( manuscript in preparation ): age, sex, menopause, body mass index, bisphosphonate use, denosumab use, current glucocorticoid dose, proton-pump inhibitor use, history of vertebral fractures, health assessment questionnaire scores, alkaline phosphatase levels, and gamma-glutamyltransferase levels. Multiple imputation by chained equations was used to handle missing data. Results 198 patients were included. The mean age was 68 ± 11 years, 68% were females, and the most common diseases were PMR (36%), giant cell arteritis (26%), and granulomatosis with polyangiitis (17%). The mean minimum T-score was -1.74 ± 0.9. Five patients had a disease duration of less than three months. In both unadjusted (Figure 1) and adjusted analysis, exercise was positively associated with minimum T-scores (unadjusted: β = 0.36; 97.5% CI 0.09 to 0.63; p = 0.01; adjusted: β = 0.30; 0.04 to 0.56; p = 0.02). In exercising patients, there was no association between frequency and minimum T-scores (p(ANOVA) = 0.66. Conclusion In PMR and vasculitis, exercise is positively associated with BMD. We adjusted for several covariates, including health assessment questionnaire scores, so it is unlikely that the association between exercise and BMD is only caused because generally healthier patients have a higher likelihood of exercising. However, we found no dose-response relationship by looking at exercise frequency. This is probably due to confounding caused by different kinds of exercises. E.g., weight-bearing exercise is thought to be more effective in elevating BMD. Furthermore, our analysis might have been underpowered (too few patients) to assess differences within the group of exercising patients. Our findings underpin the general advice given to most patients suffering from low bone mass or OP irrespective of their underlying disease, which is to start or to continue exercising within the scope of personal possibilities. Of note, this study is of cross-sectional nature and must be interpreted accordingly as residual confounding cannot be fully ruled out. We plan for the future longitudinal analyses. Figure 1. Acknowledgements Funding Rh-GIOP is supported by a joint funding from Amgen, Biogen, BMS, Chugai, Generic Assays, GSK, Hexal, Horizon Therapeutics, Lilly, Medac, Mundipharma, Novartis, Pfizer, Roche and Sanofi. Disclosure of Interests Andriko Palmowski: None declared, Edgar Wiebe Grant/research support from: Travel expenses from Medac, Sandra Hermann Paid instructor for: Lecture fees from AbbVie, Burkhard Muche Speakers bureau: consultancy or speaker fees and/or conference expenses from Amgen, Gilead, Galapagos, UCB and Stadapharm, Paid instructor for: consultancy or speaker fees and/or conference expenses from Amgen, Gilead, Galapagos, UCB and Stadapharm, Consultant of: consultancy or speaker fees and/or conference expenses from Amgen, Gilead, Galapagos, UCB and Stadapharm, Frank Buttgereit Speakers bureau: consultancy fees, honoraria and travel expenses from Abbvie, AstraZeneca, Grünenthal, Pfizer, and Roche, and grant support from Abbvie, Pfizer and Roche, Paid instructor for: consultancy fees, honoraria and travel expenses from Abbvie, AstraZeneca, Grünenthal, Pfizer, and Roche, and grant support from Abbvie, Pfizer and Roche, Consultant of: consultancy fees, honoraria and travel expenses from Abbvie, AstraZeneca, Grünenthal, Pfizer, and Roche, and grant support from Abbvie, Pfizer and Roche, Grant/research support from: consultancy fees, honoraria and travel expenses from Abbvie, AstraZeneca, Grünenthal, Pfizer, and Roche, and grant support from Abbvie, Pfizer and Roche